The Use Of Systemic And Topical Fluoroquinolones | Website Bệnh viện nhi đồng 2 - www.benhviennhi.org.vn

Children ‘s Hospital – Gastrointestinal Department OVERVIEW HISTORY Fluoroquinolones are highly active in vitro against both Gram (-) and Gram (+) pathogens and have pharmacokinetic properties that are favorable for treating a wide array of infections Drugs: acid nalidixic, norfloxacin, ofloxacin, levofloxacin, moxifloxacin ciprofloxacin, OVERVIEW Generation Drug Names Spectrum 1st Nalidixic acid Gram (-) but not Pseudomonas species 2nd Norfloxacin Ciprofloxacin Enoxacin Ofloxacin Gram (-) (including Pseudomonas species), some Gram (+) (S aureus) and some atypicals 3rd Levofloxacin Sparfloxacin Gemifloxacin Same as 2nd generation with extended Gram (+) and atypical coverage Moxifloxacin Same as 3rd generation with broad anaerobic coverage 4th OVERVIEW HISTORY Nalidixic acid: First generation approved by the FDA ≥ months Ciprofloxacin: Second generation used in children (2004) - 17 years of age OVERVIEW In 2006, according to the American Academy of Pediatrics: Parenteral fluoroquinolones: multidrug - resistant pathogens appropriate for Oral fluoroquinolones: for outpatient management, when other options were intravenous antibiotics SAFETY RCT of Bayer: 684 children from – 17 years old Compared: (1) intravenous ceftazidime with intravenous ciprofloxacin (2) oral ciprofloxacin with oral cefixime or TMP - SMX No difference to suggest musculoskeletal toxicity with ciprofloxacin potential SAFETY A large cohort of Johnson & Johnson: 2523 children in years Community acquired Pneumonia: months - 16 years Acute otitis media: months - years No change in height percentile; improvement or deterioration in growth of levofloxacin group SAFETY WHO: There is no definite evidence to show that they induce sustained injury to developing joints in children Quinolone is safe and effective in children USE OF QUINOLONE IN PEDIATRICS • Conjunctivitis • External Otitis • Acute Otitis Media, Sinusitis • Lower Respiratory Tract Infections • Gastrointestinal Infections • Urinary Tract Infection • Mycobacterial Infections USE OF QUINOLONE IN PEDIATRICS GASTROINTESTINAL INFECTION Shigellosis: Ampicillin and TMP - SMX resistance is increasing RCT in 201 children compared ciprofloxacin with Ceftriaxone equivalent between groups Multi – center RCT in VN: ciprofloxacin and gatifloxacin are similarly effective for the treatment of acute shigellosis GASTROINTESTINAL INFECTION Campylobacter : Resistance rates are increasing in many parts of the world In Taiwan, Thailand and Sweden rates of 57%, 84%, and up to 88% GASTROINTESTINAL INFECTION Gram (-) neonatal sepsis: 116 neonates with sepsis were treated successfully with ciprofloxacin No adverse events were observed used for treating Gram (-) sepsis in neonatal H PYLORI INFECTION Adult patients: levofloxacin in 2nd line triple therapy Children: 2007: o 110 patients from - 18 years o 16.4% failed to respond to the triple and then quadruple regimen was successful with LML (Levofloxacin + Metronidazole + Lanzoprazole) 2011 NASPGHAN & ESPGHAN: PPI + Levofloxacin (Moxifloxacin) + Amoxicillin (2nd line or salvage therapy) THANKS FOR ATTENTION ... approved by the FDA ≥ months Ciprofloxacin: Second generation used in children (20 04) - 17 years of age OVERVIEW In 20 06, according to the American Academy of Pediatrics: Parenteral fluoroquinolones: ... ciprofloxacin (2) oral ciprofloxacin with oral cefixime or TMP - SMX No difference to suggest musculoskeletal toxicity with ciprofloxacin potential SAFETY A large cohort of Johnson & Johnson: 25 23... norfloxacin, ofloxacin, levofloxacin, moxifloxacin ciprofloxacin, OVERVIEW Generation Drug Names Spectrum 1st Nalidixic acid Gram (-) but not Pseudomonas species 2nd Norfloxacin Ciprofloxacin Enoxacin Ofloxacin